Nutrition in Pregnancy

Maintaining a nutritious diet before and during pregnancy supports the healthy development of a growing baby. On the other hand, malnutrition at conception and throughout the pregnancy can cause restricted growth in the womb. Restricted growth is associated with an increased risk of prematurity, low birth weight, low blood sugar, low body temperature, and death [1, 2].

Prematurity and low birth weight are linked to respiratory problems, an abnormally slow heart rate, infections, pneumonia, jaundice, and anemia [3]. Babies whose mothers consume insufficient amounts of protein and calories, both of which are sources of energy, also have an increased risk of mental impairments during childhood along with potential heart, lung, and liver disease during adulthood [4, 5].

Protein-Energy Demands During Pregnancy

Pregnancy causes a dramatic increase in the body’s energy demands in the form of nutrients such as healthy fats, carbohydrates, and proteins that are meant to sustain the health of both the mother and baby [6]. Typically a pregnant woman will need to consistently consume a supplement that meets maternal needs by promoting an optimal protein-energy balance. This may include a high protein supplement or one that supplies both protein and calories [6].

Accordingly, oral nutritional supplements (ONS) that are taken before conception as well as during pregnancy have been shown to improve birthweight, and reduce the risk of complications during infancy and lower the risk of preterm birth or stillbirth, even for pregnant women who are malnourished [7-9]. However, a pregnant woman that is overweight or quickly gains weight during the early stages of pregnancy may need to be placed on a lower protein-calorie diet to avoid complications for herself and her baby such as heart disease [10].

Overall, the key is to use ONS to ensure that the right balance of protein and energy intake is maintained. Malnourished mothers or those whose protein intake is low during pregnancy, may need high protein and high calorie ONS to promote the optimal balance of protein and energy that meets the mother’s and baby’s needs. Conversely, a woman who is overweight at conception, is consuming large amounts of protein and calories during the pregnancy, or is rapidly gaining weight, may need lower amounts of ONS to achieve the right protein-energy balance [7-10].

According to the World Health Organization (WHO), ONS with a protein content that supplies less than 25% of the total energy requirement for malnourished mothers promotes healthy weight gain for the baby and positive pregnancy outcomes, while high protein supplementation does not always appear to benefit the baby and may even cause a baby harm [11].

Challenges during a pregnancy that can make it difficult to obtain the right amounts of essential nutrients include severe morning sickness (hyperemesis gravidarum), food aversion, nausea, and fatigue, among others [12]. In such cases, ONS in whatever form can be taken (e.g., liquid, tablet, gummy) or through an intravenous needle (IV) for women suffering from intense morning sickness, helps ensure that both the mother and baby are receiving the amounts of protein and energy the body needs to promote survival and optimal health.

References

  1. Imdad A, Bhutta ZA. Effect of balanced protein energy supplementation during pregnancy on birth outcomes. BMC Public Health. 2011;11 Suppl 3:S17.
  2. Ashworth A. Effects of intrauterine growth retardation on mortality and morbidity in infants and young children. Eur J Clin Nutr. 1998; 52 Suppl 1:S34-41.
  3. Liberato SC, Singh G, Mulholland K. Effects of protein energy supplementation during pregnancy on fetal growth: a review of the literature focusing on contextual factors. Food Nutr Res. 2013;57.
  4. Ferro-Luzzi A, Ashworth A, Martorell R, et al. Report of the IDECG Working Group on effects of IUGR on infants, children and adolescents: immunocompetence, mortality, morbidity, body size, body composition, and physical performance. Eur J Clin Nutr. 1998; 52 Suppl 1:S97-9.
  5. Martorell R, Ramakrishnan U, et al. Intrauterine growth retardation, body size, body composition and physical performance in adolescence. Eur J Clin Nutr. 1998 Jan; 52 Suppl 1:S43-52.
  6. Kind KL, Moore VM, Davies MJ. Diet around conception and during pregnancy–effects on fetal and neonatal outcomes. Reprod Biomed Online. 2006;12(5):532-41.
  7. Kramer MS, Kakuma R. Energy and protein intake in pregnancy. Cochrane Database Syst Rev. 2003;(4):CD000032.
  8. Stevens B, Buettner P1, et al. The effect of balanced protein energy supplementation in undernourished pregnant women and child physical growth in low- and middle-income countries: a systematic review and meta-analysis. Matern Child Nutr. 2015;11(4):415-32.
  9. Ota E1, Tobe-Gai R, et al. Antenatal dietary advice and supplementation to increase energy and protein intake. Cochrane Database Syst Rev. 2012;(9):CD000032.
  10. Leddy MA, Power ML, Schulkin J. The impact of maternal obesity on maternal and fetal health. Rev Obstet Gynecol. 2008;1(4):170-8.
  11. World Health Organization (WHO). Balanced energy and protein supplementation during pregnancy, 2019. https://www.who.int/elena/titles/energy_protein_pregnancy/en/
  12. Lee NM, Saha S. Nausea and vomiting of pregnancy. Gastroenterol Clin North Am. 2011;40(2):309-34.